The form provided as text below and also available as an MS Word document can be signed, scanned, and e-mailed as an attachment to email@example.com or printed, signed, and mailed to Quaker Archives, Guilford College, 5800 West Friendly Avenue, Greensboro, NC 27410.
I, [full legal student name as it appear on diploma and thesis cover page], as author with the authority to grant copyright permissions for the aforementioned title, hereby authorize Guilford College to digitize, distribute, and archive the following title for nonprofit, educational purposes via the Internet or successive technologies:
[Full Official Thesis Title, Year]
This is a non-exclusive grant of permissions for online and off-line use for an indefinite term. Off-line uses shall be consistent either, for educational uses, with the terms of U.S. copyright legislation's "fair use" provisions or, by Guilford College, with the maintenance and preservation of an archival copy. Digitization allows Guilford College to generate image-based and text-based versions as appropriate to maintain file access over time and to provide and enhance access using search software.
This grant of permissions prohibits use of the digitized versions for commercial use or profit.
Printed or Typed Name Author
Date of Signature